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TRANSCRIPT
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To Infinity and
Beyond:
What’s Next in Telehealth
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Objectives
• Discuss new eCARE initiatives in progress
• Describe how new services will enhance patient care
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Avera eCARE™
eCARE Vision: To improve the health and lives of people and communities through advanced
technologies and improved access to health care.
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Access to Care is
Critical
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eCARE Supports the Rural Workforce
• Access to colleagues & support for providers, nurses and pharmacists
• Availability of specialist consultants
• Staff retention
• Recruitment of new providers and nurses
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eCARE Supports Rural Communities
• Keep care local
– Increase service offerings
– Additional revenues for diagnostics & ancillary services
– New inpatient revenues
– Patients heal better at home
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Avera eCARE Services
Avera eCARE
eConsult Avera eICU
CARE ePharmacy eEmergency
eLong Term Care
eUrgent Care -
Prisons
eCARE Future
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eCARE in 2010
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eEmergency
•Provides immediate access
to Board Certified Emergency
Physicians and experienced
emergency nurses 24/7.
• Supports local providers and nurses in treating
trauma, AMI, stroke, and other critical conditions.
• Allows rural hospitals to:
– Access specialty consults
– Initiate diagnostic testing before local provider arrival
– Streamline emergency transfer arrangements
– Eliminate unnecessary transfers
– Obtain additional nursing support
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eEmergency
• 65 Sites Live • Over 362,000 Square Miles Covered • More than 4,600 Patients Treated • 8,700 Transfers Arranged • Over 800 Transfers Avoided • Estimated $4M in Transfer Savings
Cardiac 23%
Neuro 15%
Other 14%
Minor Trauma
14%
Major Trauma
10%
Respiratory Distress
9%
Behavioral Health
7%
Abd Pain 6%
Ortho 2%
Chief Complaints
0
200
400
600
800
1000
1200
Q4 2009 Q1 2010 Q2 2010 Q3 2010 Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012
eEmergency Encounters by Quarter
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In The News
KSTP News 11/2/2011
'E-Emergency' Rooms at Forefront of 21st Century Hospital Care
http://kstp.com/article/stories/S2356386.shtml?cat=11854
http://kstp.com/article/stories/S2356386.shtml?cat=11854http://kstp.com/article/stories/S2356386.shtml?cat=11854http://kstp.com/article/stories/S2356386.shtml?cat=11854
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Avera eICU® CARE
• Provides around-the-clock, remote intensive care monitoring of critically ill patients by team of critical care physicians and nurses.
• Supports bedside clinicians with a centralized, Intensivist-led care team that uses technology to continuously monitor, assess, and intervene on patients.
• Recognizes and addresses negative trends in vital signs faster than traditional care models.
• Supports consistent application of evidence-based medicine.
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eICU®
• 33 Sites Live in 6 States
• Second pair of eyes for 42,673 patients
• Saved 830 lives
• Reduced ventilator days and Ventilator Acquired Pneumonia
• Achieved 100% compliance with Stress Ulcer Prophylaxis among Ventilated Patients
0
1
2
3
4
Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011
Avera eICU Average Ventilator Days
Avera eICU
VISICU
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ePharmacy
• Provides remote medication order
review and approval prior to first
dose, even when the local
pharmacist is not available.
• Leads to a reduction of serious safety events related to
duplication of medication, allergies, and drug to drug
interactions
• Provides 24/7 access to hospital-trained pharmacists for
assistance with dosage calculations and additional
medication questions.
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ePharmacy
• 39 Sites Live
• Over 63,000 patients served
• 8,422 serious safety events avoided
• 727,000 orders reviewed
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eConsult
• Allows rural patients to access scheduled specialty consults at their local facility through two-way video
• Video consults are supported by special stethoscopes, otoscopes, and examination cameras
• Benefits patients by providing
– Local access to specialty consults
– Saved time away from school or work
– Saved expenses of round-trip travel
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eConsult
• 88 Sites Live – 62 Originating (Patient) Sites
– 27 Specialties
– 74 Providers
• In the last 12 months:
– 5,615 Consults
– $304,602 in Patient Travel Expense Saved
– 1,366,986 Patient Miles Saved
– 15,145 Patient Travel Hours Saved
Other Services
4%
Infectious Disease
37%
Cardiology 5%
Oncology 11%
Hepatology 8% Nephrology
3%
Pulmonary 9%
Pediatrics 5%
Behavioral Health
15%
Nutrition 3%
eConsult Utilization by Specialty FY2011-2012
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eCARE PILOT PROJECTS
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• eLTC uses telehealth technologies to improve long term care staff and residents’ access to provider and specialty services, in a manner that is high-quality, convenient, and low-cost.
• Current Status:
– Pilot launched in February 2012
– 4 Sites
– 32 Residents Served
– 14 Avoided Transfers
eLong Term Care
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eLTC
Next Steps
•Prove delivery model, refine service
•Expand to additional sites
•Set up hub physician operations
•Test mobile technologies
Abd Pain 6% Cellulitis
9%
Edema 6%
Fever 9%
Minor Skin Complaint
16%
Minor Trauma
6% Musc Pain
6%
Neuro 9%
Other 9%
Shortness of Breath
6%
URI 12%
UTI 6%
Chief Complaint
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eUrgent Care in Correctional Facilities
• eCARE’s work in SD Correctional Facilities uses telehealth to provide physician-directed urgent care services to inmates, resulting in reduced unnecessary and costly transfers.
Current Status:
• Pilot launched in May 2012
• 3 sites
• Goal is to reduce cost of care by reducing transfers from the facility
• 129 Encounters; 64 Avoided Transfers (49.6%)
Minor Trauma 27%
Other 14%
Chest Pain 14%
Minor Skin Complaint
14% Neurological
14%
Musc/Skel Pain 9%
Edema 4%
Upper Respiratory
Infection 4%
Other 17%
Encounters by Chief Complaint August 2012
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Reach for the sky! What’s next for eCARE
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New Initiatives
• Development of the eHelm for broad eCARE expansion – Co-locate eCARE services to expand capabilities into to other
settings and specialties – Support patients and providers with a virtual multidisciplinary
team that can assist with care coordination
• eHospital • eBehavioral Health Services
– Partner with primary care and build local capacity for treating behavioral health issues
– Provide access to needed specialty services via telehealth
eCARE services across the continuum
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The eHelm A new frontier in “eHealth” medicine…
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The goal of the “eHelm” is to improve
healthcare quality and patient
outcomes; decrease costs related to
health care service delivery; and most
significantly, improve health care
access for rural populations.
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• The eHelm is:
– The first telehealth center in the world to provide around-the-clock access to Intensivists, emergency physicians, hospital-trained pharmacists and experienced nurses.
– An incubator for innovation.
– A center for collaboration and implementation of team-based care models.
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Pat
ien
t H
om
e
Navigation Center
Interdisciplinary Teams Nursing / Counseling / Pharmacy / Dietary
eICU
Specialty Consultants (Neuro/Cardio/Nursery)
ePharmacy
Customer Service & Follow up Calls
eHELM
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The eHelm
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eHospital
•Use existing telemedicine
equipment to support local
physicians during on-call hours
•Expand formal and informal
access to specialist
consultants
•Offer collegial support to local
nursing and physician staff
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eBHS Concept Model
ER Services
Pharmacogenomics
eBHS Consults
Learning Collaborative:
Training , Multidisciplinary Case Conferences, Physician-to-Physician
Consults
Screening & Navigation Center:
PHQ-9 & Anxiety Screening in Primary Care, Navigation Center Treatment Plan Support
Use Masters-Level Counselors to provide eCARE support for behavioral health crises in emergency rooms, using evidence based medicine .
Midlevel Providers under the direction of a Psychiatrist to provide behavioral health care via telehealth. Both one-time patient visits and ongoing care.
PCPs screen patients annually & send scores to Nav Center who provides 180 day tx plans & ongoing support to PCPs.
Fill Specialty
Care Gaps
Partner with
Primary Care & Build Local
Capacity
Pharmcogenomics testing with DMET chip for patients with 2 medication failures.
Support PCPs through quarterly education sessions, quarterly case conferences, and time available for peer consults.
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Hospital Innovations
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Home Care Innovations
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The Virtual Health Home
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Anywhere you go…
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Even Where You Least Expect It…
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Questions? Comments?
Sarah Kappel, RN, BSN
eCARE Quality & Development
605-322-4702